Imipramine - Oral

Imipramine is used to treat depression in adults.

This medicine may also be used to treat night-time bed-wetting in children.

Take Imipramine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

You may take this medicine with or without food.

For children experiencing bed-wetting, it is best to take Imipramine before bedtime.

Imipramine is available as a tablet or oral solution.

If you are taking the oral solution, use the measuring spoon or cup provided to measure your dose.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the type of your condition and response to the medication.

Imipramine must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking Imipramine suddenly as it may worsen your condition.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

If you often forget to take your medicine, let your doctor and pharmacist know.

Alert your doctor if you have the following conditions:

• recovering from a recent heart attack
• any degree of heart block or heart rhythm disorder
• acute porphyria (an inherited disorder that causes skin or nervous system abnormalities)
• severe liver disease

as Imipramine may not be suitable for you.

Do not take Imipramine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.

Inform your doctor if you have the following conditions:

• heart disease e.g. rapid heartbeat
• stroke
• diabetes
• glaucoma (increased pressure in the eye)
• current or history of epilepsy (fits or seizures)
• history of having thoughts of self-harm
• bowel problems e.g. long-term constipation, paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
• enlarged prostate gland
• overactive thyroid gland
• myasthenia gravis (muscle weakness disorder)
• phaeochromocytoma (rare tumour of the adrenal gland causing high blood pressure)
• mild to moderate liver disease
• kidney disease

Let your doctor know if you are pregnant or breastfeeding.

Be sure to check with your doctor or pharmacist before giving Imipramine to a child and the elderly. Children or elderly people may be more sensitive to the side effects.

Notify your doctor if you have recently undergone electroshock therapy (also known as electroconvulsive therapy or ECT).

Medicines for depression such as Imipramine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.

Some genetic traits can affect the efficacy of Imipramine. Individuals who are CYP2C19 ultrarapid or rapid metabolisers and CYP2D6 ultrarapid metabolisers may have poor response to this medicine, while those who are CYP2C19 and CYP2D6 poor metabolisers may have enhanced side effects of Imipramine. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this drug is best suited for you. If you know you have this gene type, inform your doctor.

If you are going to have an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking this medicine.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Routine tests (e.g. complete blood count, blood sugar and sodium levels) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Your blood pressure may drop to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.

What lifestyle changes should I make to cope with depression?

Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.

Imipramine may cause drowsiness, dizziness or blurred vision. If affected, do not drive or take part in any activity in which you need to be alert or need to see clearly.

This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.

Imipramine may also make your skin more sensitive to sunlight. Apply sunscreen when going outdoors and avoid prolonged exposure to sunlight and UV lamps.

Other side effects include any of the following: headache, tiredness, nausea, vomiting, constipation, weight gain, dry mouth, hot flushes, sweating, loss of appetite, and sleep disturbances.

Some side effects may need immediate medical help. Alert your doctor immediately if you experience any of the following:

• having thoughts of self-harm
• unusual changes in mood or behaviour (being too depressed or having compulsive and impulsive behaviour)
• agitation, confusion, hallucinations (seeing, hearing or feeling things that are not existent), fever, fast heartbeat, excessive sweating, muscle stiffness or spasms
• chest pain, irregular or fast heartbeats
• difficulty passing urine
• fits or seizures
• frequent sore throat, mouth sores, fever, chills or sweating

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Do not take Imipramine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.

Inform your doctor and pharmacist if you are taking any of these medicines:

• strong painkillers e.g. buprenorphine, tramadol
• other medicines used to treat depression e.g. fluoxetine, fluvoxamine, paroxetine
• medicines for high blood pressure e.g. clonidine, guanethidine, propranolol, labetalol, verapamil
• medicines used to treat Parkinson's disease (disorder that affects the movement of a person, causing symptoms such as tremors, muscle stiffness, slowed movement and impaired balance or walking) e.g. biperiden
• medicines for fits or seizures e.g. carbamazepine, phenytoin, phenobarbital
• medicines for mood disorders e.g. chlorpromazine, thioridazine, lithium
• medicines for irregular heartbeat e.g. quinidine
• blood-thinning medicines e.g. warfarin
• medicines for HIV infection e.g. ritonavir
• cimetidine (medicine that reduces stomach acid production)
• methylphenidate (medicine to treat hyperactivity disorders)
• altretamine (medicine for cancer)
• birth control pills

This list does not include all medicines that may interact with Imipramine.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicine, supplements, and medicines that you buy without a prescription.

Avoid alcohol. Alcohol intake may worsen the dizziness and drowsiness caused by Imipramine.

Store in a cool, dry place away from the reach of children.

Protect from light and moisture.

Medicines must not be used past the expiry date.